Effectiveness of caudal septal extension graft application in endonasal septoplasty☆

Karadavut, Yunus; Akyıldız, Ilker; Karadaş, Hatice; Dinç, Aykut Erdem; Tulacı, Gökçe; Tastan, Eren

doi:10.1016/j.bjorl.2016.01.014

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Brazilian Journal of Otorhinolaryngology

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Sumário

Original articles • Braz. j. otorhinolaryngol. 83 (1) • Jan-Feb 2017 • https://doi.org/10.1016/j.bjorl.2016.01.014 copy

Effectiveness of caudal septal extension graft application in endonasal septoplasty^☆ ☆ Please cite this article as: Karadavut Y, Akyıldız I, Karadaş H, Dinç AE, Tulacı G, Tastan E. Effectiveness of caudal septal extension graft application in endonasal septoplasty. Braz J Otorhinolaryngol. 2017;83:59-65.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Septal deviation is a common disease seen in daily otorhinolaryngology practice and septoplasty is a commonly performed surgical procedure. Caudal septum deviation is also a challenging pathology for ear, nose, and throat specialists. Many techniques are defined for caudal septal deviation.

Objective

To evaluate the effectiveness of caudal septal extension graft (CSEG) application in patients who underwent endonasal septoplasty for a short and deviated nasal septum.

Methods

Forty patients with nasal septal deviation, short nasal septum, and weak nasal tip support who underwent endonasal septoplasty with or without CSEG placement between August 2012 and June 2013 were enrolled in this study. Twenty patients underwent endonasal septoplasty with CSEG placement. The rest of the group, who rejected auricular or costal cartilage harvest for CSEG placement, underwent only endonasal septoplasty without any additional intervention. Using the Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) questionnaires, pre- and post-operative acoustic rhinometer measurements were evaluated to assess the effect of CESG placement on nasal obstruction.

Results

In the control group, preoperative and postoperative minimal cross-sectional areas (MCA1) were 0.44 ± 0.10 cm² and 0.60 ± 0.11 cm², respectively (p < 0.001). In the study group, pre- and postoperative MCA1 values were 0.45 ± 0.16 cm² and 0.67 ± 0.16 cm², respectively (p < 0.01). In the control group, the nasal cavity volume (VOL1) value was 1.71 ± 0.21 mL preoperatively and 1.94 ± 0.17 mL postoperatively (p < 0.001). In the study group, pre- and postoperative VOL1s were 1.72 ± 0.15 mL and 1.97 ± 0.12 mL, respectively (p < 0.001). Statistical analysis of postoperative MCA1 and VOL1 values in the study and the control groups could not detect any significant intergroup difference (p = 0.093 and 0.432, respectively). In the study group, mean nasolabial angles were 78.15 ± 4.26º and 90.70 ± 2.38º, respectively (p < 0.001).

Conclusion

Endonasal septoplasty with CESG placement is an effective surgical procedure with minimal complication rate for subjects who have a deviated, short nasal septum and weak nasal tip support.

Keywords
Nasal septum; Nasal cartilage; Nasal obstruction; Intranasal surgery; Grafting

	Mild problem	Moderate problem	Bad problem	Severe problem
Nasal congestion or stuffiness	1	2	3	4
Frequency of nasal congestion	1	2	3	4
Trouble breathing through your nose	1	2	3	4
Trouble sleeping	1	2	3	4
Unable to get enough air through your nose during exercise or exertion	1	2	3	4

	Control			CSEG			Control-study comparison
	Preop.	Postop.	p	Preop.	Postop.	p	Preop.	Postop.
Question 1	3	2	<0.001	3	0 (0–1)	<0.001	0.799	<0.001
Question 2	3	2	<0.001	3	1 (0–1)	<0.001	0.289	<0.001
Question 3	3	2	<0.001	4	0 (0–1)	<0.001	0.183	<0.001
Question 4	3	2	<0.001	3	1 (0–2)	<0.001	0.035	<0.001
Question 5	3	2	<0.001	3	1 (0–2)	<0.001	0.289	<0.001

	Control			CSEG			Control-Study comparison
	Preop.	Postop.	p	Preop.	Postop.	p	Preop.	Postop.
Question 1	2	2	0.046	1 (0–2)	3 (1–3)	<0.001	0.026	0.049
Question 2	1	3	<0.001	0 (0–2)	4 (3–4)	<0.001	0.165	0.602
Question 3	2	2	0.046	1 (0–3)	3 (0–3)	<0.001	0.007	0.253
Question 4	1	2	0.001	2 (0–4)	3 (2–4)	<0.001	0.063	<0.001
Question 5	1	1	0.083	2 (0–3)	3 (1–4)	<0.001	0.265	<0.001
Question 6	1	2	<0.001	2 (0–3)	3 (2–4)	<0.001	0.799	0.038

	Preop.	Postop.	p
Nasolabial angle of the study group (NLA)	78.15 ± 4.246	90.70 ± 2.386	<0.001
Nasolabial angle of the control group	76.254 ± 3.954	76.853 ± 4.025	>0.001

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] *Corresponding author. E-mail:ilkerakyildiz@yahoo.com (I. Akyıldız).

Do you like the external view of your nose?	0 (No)	1	2	3	4 (Yes)
How well do you breathe?	0 (Not at all)	1	2	3	4 (Very well)
Do you think your friends like your nose?	0 (Not at all)	1	2	3	4 (Always)
Does your own nose restrict your social and professional activity?	0 (Always)	1	2	3	4 (Never)
Do you think that your nose is as good as possible?	0 (Not at all)	1	2	3	4 (Yes)
Do you want to change your nose appearance and function via an operation?	0 (Absolutely)	1	2	3	4 (No)